The Effects of Adding G-CSF to the Induction Therapy of Patients with AML Being Treated with the 7+3 Protocol: A Retrospective Comparative Study.

Abstract

Background: Although some new treatment protocols have been developed, 7+3 chemotherapy is still the most widely used treatment for acute myeloid leukemia (AML) induction therapy. Granulocyte colony-stimulating factor (G-CSF) is a widely used treatment modality for myelosuppression after chemotherapy as it accelerates myeloid healing and reduces the incidence and severity of fever and infections. Most current guidelines recommend primary G-CSF prophylaxis in solid cancer patients with a risk of ≥20% febrile neutropenia. However, the use of G-CSF in the induction treatment of AML is controversial as it increases the proliferation of leukemic blasts in vitro.

Aim: This study was to investigate the effects of G-CSF use in AML induction therapy on survival.

Methods: The study group included 36 patients over the age of 18 with bone marrow blast rate >20% who were diagnosed with AML [M0-M5 according to FAB (French-American-British) classification] using diagnostic tests, such as flow cytometry and bone marrow biopsy between 2016 and 2020. Eighteen of these patients were from a center that employed prophylactic G-CSF during induction therapy, and the remaining 18 patients were from another center that did not employ prophylactic G-CSF during induction therapy. The characteristics of the patients were reviewed retrospectively from their files. The induction therapy used was 7+3 (7-day cytarabine +3-day idarubicin) chemotherapy regimen.

Results: Although not reaching statistically significant levels, the use of G-CSF in AML induction therapy was found to provide both OS and PFS advantages. In addition, patients who used G-SF had statistically significantly fewer intensive care unit (ICU) stays than those who did not use it.

Conclusion: Although the use of G-CSF in induction therapy of AML patients did not significantly increase survival rates, it caused a statistically significant decrease in the need for intensive care. However, larger-scale studies with longer follow-up periods are needed to confirm the results of this study.